Ongoing hospital-based surveillance of acute infectious neurological disease in Guatemala has uncovered a high incidence of acute flaccid paralysis (AFP) in both children and adults. Anecdotal sporadic reports of clusters of AFP with unusual clinical presentation and unknown etiology have also been noted in other Latin American countries. The rapid onset, clinical progression and severity of outcome of the cases in Guatemala suggest they are distinct from the recognized variants of Guillain-Barr[unreadable] syndrome (the most common cause of AFP), but crucial data necessary for elucidating the epidemiology and etiology of AFP in Guatemala are lacking. The long-term goal of our research is to identify intervention points for populations at risk for AFP and to evaluate control strategies for AFP in Latin America by: a) initiating investigations into the underlying etiologies and clinical subtypes of AFP syndrome in adults and children in Guatemala, and b) fostering collaborations for future multisite investigations of AFP across Latin America. Specifically, we will perform a case-control study using AFP patients and hospital controls presenting to Ministry of Health hospitals in Guatemala City to: 1) characterize the clinical, laboratory, and electrodiagnostic features of cases of AFP syndrome in adults and children; 2) compare the epidemiological characteristics, including potential risk factors and socioeconomic variables, between AFP cases and hospital controls, and 3) compare serologic and fecal (culture, PCR, ELISA) evidence of infection with specific suspect etiological agents in AFP cases and controls. We will also develop a collaborative AFP network of public health researchers and clinicians throughout Latin America to forge long-term working relationships aimed at future multisite investigations of AFP epidemiology and prevention in Latin America. Monthly teleconferences and an e-mail forum will promote dissemination and discussion of information regarding patterns and characteristics of AFP cases throughout the region. If preliminary results of the proposed study indicate that specific infectious agents represent significant public health concerns, the feasibility of transferring technology for in-country diagnostic testing for these agents will be examined. The information gathered and relationships forged during the proposed project will support development of a large-scale multisite investigation of potential clinical and public health interventions for AFP in Latin America. [unreadable] [unreadable] [unreadable]